Sentinel lymph node biopsy in early breast cancer patients: a single-institution Armenian experience
Metaksya L. Mkrtchyan, Gagik K. Bazikyan, Artur A. Avetisyan, Narek V. Manukyan,
Mher D. Kostanyan, Zara S. Harutyunyan, Anna A. Melkonyan, Satine G. Karamyan , Susanna G. Aleksanyan, Nelli H. Grigoryan, Sona A. Jilavyan, Naira R. Harutyunyan ,
Haykuhi K. Gyokchyan, Nerses S. Karamyan, Karen H. Carukyan,
Anahit V. Gyunashyan, Khoren E. Amirkhanyan
“Women’s Health clinic” Department, Fanarjian National Center of Oncology (FNCO), Yerevan, Armenia
Seinyan Department of Bone Oncology, FNCO, Yerevan, Armenia
Department of General and Pediatric Oncology and Reconstructive Surgery, FNCO, Yerevan, Armenia
Department of Oncogynecology ٢, FNCO, Yerevan, Armenia
Department of Clinical Pathomorphology, FNCO, Yerevan, Armenia
Department of Diagnostic Services, FNCO, Yerevan, Armenia
Department of Oncology, Heratsi Yerevan State Medical University, Yerevan, Armenia
Department of Nuclear medicine, FNCO, Yerevan, Armenia
Department of Chemotherapy, Erebuni Medical Center, Yerevan, Armenia
Department of Radiotherapy, FNCO, Yerevan, Armenia
Department of Oncourology, FNCO, Yerevan, Armenia
ABSTRACT
Background: In the context of breast cancer (BC) management, sentinel lymph node biopsy (SLNB) has gained prominence as a minimally invasive alternative to axillary lymph node dissection (ALND). Over the past decades, the paradigm of BC surgical management has witnessed a shift from aggressive procedures to more conservative approaches. However, in lower middle-income countries, the adoption of SLNB encounters multifaceted challenges, including limited resources, training gaps, and financial constraints.
Purpose: This study delves into adoption of SLNB in a public hospital within an upper middle-income country. It sheds light on the complex dynamics of introducing innovative surgical techniques in resource-constrained environments.
Methods: This single-center retrospective and prospective study focuses on patients who underwent surgical interventions for early-stage BC between 2020 and 2022 in a public hospital. Two groups were examined: one underwent SLNB using indocyanine green and gamma probe detector, while the other group underwent ALND.
Results: The study included 400 patients diagnosed with early-stage BC. Key findings included the predominance of invasive ductal carcinoma, ER/PR-positive, HER2-negative BC, and grade 2 tumors. Most patients (95.3%) received radiotherapy and hormonotherapy (85.3%) without differences between SLNB and ALND groups, while chemotherapy was more frequent in the ALND group (79.7% vs. 22.8%; P < 0.001).
Conclusion: The introduction of SLNB in an upper middle-income country faces challenges related to resources, training, and financial constraints. Despite these barriers, innovative strategies, such as indocyanine green-based SLNB, offer potential solutions. By navigating these obstacles, the integration of SLNB can optimize BC care delivery and improve patient outcomes in resource-constrained settings.
Keywords: lymph node biopsy, breast cancer, upper middle-income country, surgical innovation, resource constraints, indocyanine green, minimally invasive, diagnostic accuracy